Healthcare Provider Details

I. General information

NPI: 1083158224
Provider Name (Legal Business Name): SONIA GALLEGOS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BAILEY AVE SUITE 2
NEEDLES CA
92363-3105
US

IV. Provider business mailing address

1600 BAILEY AVE SUITE 2
NEEDLES CA
92363-3105
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-9313
  • Fax: 760-326-2864
Mailing address:
  • Phone: 760-326-9313
  • Fax: 760-326-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW31554
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW31554
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: